Apparatus for corneal curvature adjustment

ABSTRACT

A system for adjusting the curvature of the cornea of the eye involves inserting a plastic split end adjusting ring into the stroma of the cornea by first making a first incision in the cornea above the corneal ring at about the eight millimeter chord, then inserting one end of a metal split end dissecting ring into the incision with the trailing end of the dissecting ring remaining outside the cornea. The one end of the dissecting ring has a transverse hole therein near its tip end. The dissecting ring is held by a magnetic holding and rotating device which has a concave end surface and circular groove therein for receiving the metal dissecting ring and for holding it in a circular shape. As the holder is rotated the inserted end of the metal ring is magnetically forced to follow rotation of the holder thus the dissecting ring is inserted in a circular path within the stroma. A sled shaped end portion of the dissecting ring causes the moving inserted end of the dissecting ring to be biased upwardly toward the anterior of the stroma as the dissecting ring is rotatably inserted therein. When the inserted end of the dissecting ring reaches the first incision its rotation is stopped and a second incision is made over the transverse hole in the dissecting ring perpendicular to and intersecting one edge of the first incision. The plastic adjusting member also has a transverse hole near its one sled shaped end which is placed next to the first incision. A connecting link member is inserted through the holes in the ends of the respective dissecting and adjusting rings to releasably join the two rings, the rotational direction of the holding tool is then reversed which &#34;backs out&#34; the dissecting ring and at the same time pulls in behind it the plastic adjusting ring. When the now joined ends of the two rings are rotated back around to the insertion point, the now withdrawn dissecting ring is released from the adjusting ring. A corneascope type image of the corneal topography is displayed on a visual surface and compared to a desired target image. Adjustment is then made in the relative position of the ends of the adjusting ring to change the shape of the cornea to bring the image of the present shape into coincidence with the desired shape whereupon the two ends of the adjusting ring are fixedly joined to maintain the desired shape.

This is a divisional application of Ser. No. 06/336,919, filed Jan. 4,1982, now U.S. Pat. No. 4,452,235.

BACKGROUND OF THE INVENTION

This invention relates to a method and apparatus for adjusting the shapeof components of the eye and more particularly to making fixed changesin the corneal curvature.

Deviations form the normal shape of the corneal surface produce errorsof refraction in the visual process. The eye in a state of rest, withoutaccomodation, focuses the image of distant objects exactly on theretina. Such an eye enjoys distinct vision for distant objects withouteffort. Any variation from this standard constitutes ametropia, acondition in which the eye at rest is unable to focus the image of adistant object on the retina. Hyperopia is an error of refraction inwhich, with the eye at rest, parallel rays from distant objects arebrought to focus behind the retina. Divergent rays from near objects arefocused still further back. In one aspect of hypertopia, the cornealsurface is flattened which decreases the angle of refraction of rays asthey pass through the refractive surfaces of the cornea, causing aconvergence or focus of the rays at a point behind the retina. Theretina is comprised partially of nerve fibers which are an expansion ofthe optic nerve. Waves of light falling on the retina are converted intonerve impulses and carried by the optic nerve to the brain to producethe sensation of light. To focus parallel rays on the retina, thehyperopic eye must either accomodate, i.e., increase the convexity ofits lens, or a convex lens of sufficient strength to focus rays on theretina must be placed before the eye.

Myopia is that refractive condition in which, with accomodationcompletely relaxed, parallel rays are brought to focus in front of theretina. One condition which commonly causes myopia is when the cornealcurvature is steepened, thus the refraction of rays is greater as theypass through the refractive surfaces of the cornea, and the overrefracted rays converge or focus in front of the retina in the vitreousof the eye. When the rays reach the retina they become divergent,forming a circle of diffusion and consequently a blurred image. Aconcave lens is used to correct the focus of the eye for myopia.

The normal treatment of these classic forms of refractive error of theeye is with the use of eyeglasses or contact lenses, both of which havewell-known disadvantages to the user. Recent research has been directedto operative techniques to change the refractive condition of the eye.Such techniques are generally referred to "keratorefractive techniques".Two such techniques are more particularly called keratophakia andkeratomileusis. Keralomileusis involves the regrinding of a corneallamella into a meniscus or hyperopic lens to correct myopia orhyperopia. A corneal optical lathe has been especially developed forthis procedure and is also used in the keratophakia procedure, when ahomograft ground into a convex lens is placed interlamellarly to correctaphakic hypermetropia. The homograft tissue (corneal lamella) is frozenwith carbon dioxide. The homograft is cut as a contact lens would be,i.e., to the optical power required to effect the desired opticalcorrection of the cornea. In keratomileusis, the anterior corneallamella is shaped by the lathe and in keratophobia, it is the cornealstroma of a donor eye that is shaped by the lathe. These techniques havea broad application in the correction of high hyperopic and myopicerrors. These procedures require radial cutting of the cornea about theperiphery of the graft which weakens the cornea so that pressure fromfluids below the incisions pushes up under the cuts and flattens thecurvature of the cornea. This flattening of the cornea results inrefractive errors to the eye not compensated for by the graft. Suturingin these operations also causes radial asymmetry of the corneaconsequently promotes astigmatic error in this regard. Sutures alsocause scarring of the corneal tissue, which scar tissue loses itstransparency. Surgical correction of astigmatism is accomplished byasymmetrically altering the corneal curvatures. The effect of aperipherical distoring force may be easily visualized by imagining aninflated balloon with a spherical surface being compressed between thepalms of the hands. Because the volume of air in the balloon isconstant, the surface area remains constant. The previously sphericalanterior surface is distorted meridianally as a result of compressingthe diameter between the hands so that the curvature changes withoutchanging the circumference of the surface. The meridian passing over theballoon between the extended fingers steepens, while the uncompressedmeridian at right angles thereto flattens as its diameter lengthens inproportion to the shortening of the compressed diameter. Thisdemonstrates the effect that may result from slight variations in thesymmetrical patterns or intentional asymmetrical patterns attempted tobe accomplished during surgical procedures and attendant suturing. It isthus seen that present procedures in keratorefractive techniques arebest limited to situations where other more standard correctivepractices are found ineffective. It is readily seen that the limitingfactors in such surgical techniques is the gross complexity involved notonly with multiple incisions in corneal tissue for affecting theprocedures but also complex suturing patterns, resulting in grossrestructuring of the eye. The eye is thus faced with a difficult job ofadjusting to this trauma.

It is therefore an object of the present invention to provide a new andimproved keratorefractive technique involving method and apparatus forchanging the shape of the optical zone of the cornea to correctrefractive error whereby a minimum disturbance is imposed on the eyesystem and the simplicity of the technique virtually eliminates thechance of error or further complications resulting from grossdisturbances of the eye system.

SUMMARY OF THE INVENTION

With this and other objects in view of the present inventioncontemplates a method and apparatus involving inserting one end of asplit end adjusting ring in the cornea of the eye and moving the ring ina circular path until its ends meet, whereby the ends are adjustedrelative to one another until the shape of the eye has assumed a desiredcurvature whereupon the ends are fixedly attached to maintain thedesired curvature of the cornea.

Another aspect of the invention involves an ovaloid cross sectionalshape of the adjusting ring which when inserted in the cornea isarranged to have its major cross sectional axis aligned with a cornealarc extending through the anterior pole of the cornea.

An additional aspect of the invention involves a dissecting ring whichhas split end portions, with one end being inserted into the corneaprior to insertion of the adjusting ring. Such one end is then moved ina circular path about the interior of the cornea until it reaches theinsertion point, whereupon the one end of the adjusting ring isreleasably attached to the one end of the dissecting ring and thedissecting ring is then moved in a reversed circular path, pulling thenow attached adjusting ring behind it until the one end of thedissecting ring has returned to the insertion point. At this time theone end of the adjusting ring has also circularly moved about theinterior of the cornea until its one leading end has reached theinsertion point to implant the adjusting ring in the cornea and withdrawthe dissecting ring. The corneal curvature adjusting procedure and ringend fixing procedure are then performed.

Still another aspect of the invention is the shape of the one leadingend of the respective dissecting ring and adjusting ring which isasymmetrically rounded into a sled shape to maintain a transverse biason the one ends as they are moved within the corneal tissue.

Yet another aspect of the invention pertains to a connecting system forreleasably attaching the leading ends of the respective dissecting andadjusting rings, including holes near the tip ends of the one end of therings with longitudinal grooves extending from the holes to the tipends, and an inverted "U-shaped" clip which is inserted in the holes ofboth rings to hold the ring ends together while they are being movedabout the interior of the cornea.

Another aspect of the invention involves the use of a ring holder andmoving device which is comprised of an elongated cylindrical memberhaving a concave surface formed concentrically within its lower end andsized to fit over the curvature of the cornea, with a circular groove inthe face of the concave surface, which groove is sized to hold thedissecting ring in its circular configuration, and a means for exertinga magnetic force on the dissecting ring to cause the ring to follow therotational path of the holder when it is rotated over the eye after theone end of the dissecting ring is inserted into the corneal tissue. Thismagnetic force also pulls the dissecting ring toward the anterior of thecorneal stroma into which it is being inserted. In addition, a pinextends outwardly from the groove and serves to engage a blunt trailingend of the dissecting ring as it is being inserted to further facilitateits movement in and about the cornea as the holder is rotated. Also, acylindrical sleeve may be fitted over a portion of the elongatedcylindrical member to facilitate holding the holding device steady asthe cylindrical member is rotated in the adjusting ring insertionprocedure.

Yet still another aspect of the invention resides in providing visualindication of the present shape of the cornea together with anindication of a desired shape and comparing the indications while theadjusting ring ends are being adjusted to aid in fixing the ends of theadjusting ring at a place to provide the desired corneal topography.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic illustration of a horizontal section of the eye;

FIG. 2 is a schematic illustration of an eye system showing adjustmentof the cornea to steepen the corneal slope;

FIG. 3 is a schematic illustration of an eye system showing adjustmentof the cornea to flatten the corneal slope;

FIG. 4 is a more detailed schematic illustration of a horizontal sectionof the frontal portion of the eye showing an adjusting ring positionedin the stroma of the cornea;

FIG. 5 is a plan view of a dissecting ring showing its end portions;

FIG. 6 is a plan view of an adjustment ring showing its end portions;

FIG. 7 is an elevational view showing the inserting ends of therespective dissecting ring and adjustment rings positioned for receivinga releasable connecting clip;

FIG. 8 is an elevational view of the adjusting ring taken along lines8--8 of FIG. 6;

FIG. 9 is a partial perspective view of the cornea of an eye withincisions for receiving the dissecting and adjusting rings and the ringspositioned for releasable attachment to one another just prior toimplanting the adjusting ring;

FIG. 10 is a side elevational cross sectional view of a dissecting ringholding and rotating tool; and

FIG. 11 is a schematic representation of a cornea-scope type imagesuperimposed with a target image for comparing the present shape of thecornea with a desired shape to permit accurate fixing of the adjustmentring to fix the shape of the cornea.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring first to FIG. 1 of the drawings, a horizontal section of theeye shows the globe of the eye resembling a sphere with an anteriorbulged spherical portion 12 representing the cornea. Thus the eye isactually comprised of two somewhat modified spheres placed one in frontof the other. The anterior of these two segments is the smaller morecurved cornea.

The globe of the eye consists of three concentric coverings enclosingthe various transparent media through which the light must pass beforereaching the sensitive retina. The outermost covering is a fibrousprotective portion the posterior five-sixths of which is white andopaque and called the sclera 13, and sometimes referred to as the whiteof the eye where visable to the front. The anterior one-sixth of thisouter layer is the transparent cornea 12.

A middle covering is mainly vascular and nutritive in function and iscomprised of the choroid 14, cibiary body 15 and iris 17. The choroidgenerally functions to maintain the retina. The ciliary muscle isinvolved in suspending the lens and accomodation of the lens. The irisis the most anterior portion of the middle covering of the eye and isarranged in a frontal plane. It is a thin circular disc corresponding tothe diaphram of a camera, and is perforated near its center by acircular aperature called the pupil 19. The size of the pupil varies toregulate the amount of light which reaches the retina. It contracts alsoto accomodation, which serves to sharpen the focus by diminishingspherical aberration. The iris divides the space between the cornea 12and the lens 21 into an anterior chamber 22 and posterior chamber 23.The innermost portion of covering is the retina 18, consisting of nerveelements which form the true receptive portion for visual impressions.

The retina is a part of the brain arising as an outgrowth from thefore-brain, with the optic nerve 24 serving as a fibre tract connectingthe retina part of the brain with the fore-brain. A layer of rods andcones, lying just beneath a pigmented epitheluim on the anterior wall ofthe retina, serve as visual cells or photoreceptors which transformphysical energy [light] into nerve impulses.

The vitreous 26 is a transparent gelatinous mass which fills theposterior four-fifths of the globe. At its sides it supports the ciliarybody 16 and the retina 18. A frontal saucer-shaped depression houses thelens 21.

The lens 21 of the eye is a transparent bi-convex body of crystallineappearance placed between the iris 17 and vitreous 26. Its axialdiameter varies markedly with accomodation. A ciliary zonule 27,consisting of transparent fibres passing between the ciliary body 16 andlens 21 serves to hold the lens in position and enable the ciliarymuscle to act on it.

Referring again to the cornea 12, this outermost fibrous transparentcoating resembles a watch glass. Its curvature is somewhat greater thanthe rest of the globe and is ideally spherical in nature. However, oftenit is more curved in one meridian than another giving rise toastigmatism. A central third of the cornea is called the optical zonewith a slight flattening taking place outwardly thereof as the corneathickens towards its periphery. Most of the refraction of the eye takesplace on the surface of the cornea.

Referring to FIG. 4, a more detailed drawing of the anterior portion ofthe globe shows the various layers of the cornea comprising anepitheluim 31. Epithelial cells on the surface thereof function tomaintain transparency of the cornea. These epithelial cells are rich inglycogen, enzymes and acetylcholine and their activity regulates thecorneal corpuscles and controls the transport of water and electrolylesthrough the lamellae of the stroma 32 of the cornea.

An anterior limiting lamina 33, referred to as Bowman's membrane, ispositioned between the epithelium 31 and the substantia propria orstroma 32 of the cornea. The stroma is comprised of lamella having bandsof fibrils parallel to each other and crossing the whole of the cornea.While most of the fibrous bands are parallel to the surface, some areoblique, especially anteriorly. The fibrous bands within alternatelamella are at a near right angle to bands in the adjacent lamella. Aposterior limiting lamina 34 is referred to as Descemet's membrane. Itis a strong membrane sharply defined from the stroma and resistant topathological processes of the cornea.

The endotheluim 36 is the most posterior layer of the cornea andconsists of a single layer of cells. The limbus 37 is the transitionzone between the conjunctiva 38 and sclera 13 on the one hand and thecornea 12 on the other.

Referring next to FIG. 2 of the drawings, the globe of an eye is shownhaving a cornea 12 with a normal curvature represented by the solid line39. If parallel rays of light 41 pass through the corneal surface 39 ofFIG. 2 they are refracted by the corneal surfaces to converge eventuallynear the retina 18 of the eye. The diagram of FIG. 2 discounts, for thepurposes of this discussion, the refractive effect of the lens or otherportions of the eye. The eye depicted in FIG. 2 is hyperopic and thusthe rays of light 41 are refracted to converge at point 42 behind theretina. If a peripherial band of pressure is applied inwardly at thechord 43 of the cornea, the walls of the cornea are caused to steepen.This is because the volume of fluids within the anterior chamber 22remains constant, thus the anterior portion of the cornea, including theoptical zone (inner third of the cornea) steepens in slope to form acurvature (shown in exaggeration) following the dotted line 44. The raysof light 41 are then refracted from the steeper surface 44 at a greaterangle to direct the refracted rays into focus at a shorter distance,such as directly on the retina 18.

FIG. 3 shows a similar eye system to that of FIG. 2 except that the socalled normal corneal curvature of FIG. 3 causes the light rays 41 torefract into focus at a point 46 in the vitreous which is short of theretinal surface 18. This is typical of a myopic eye. If chord 43 of thecornea is expanded uniformly outwardly as shown by the arrows, the wallsof the cornea are flattened. Light rays 41 refracted by the nowflattened corneal surface will be refracted at a smaller angle and thusconverge at a more distant point such as directly on the retina 18.

The methods and apparatus of the present invention are concerned with asystem for adjusting an annular chord of the cornea as suggested by theprocesses shown in FIGS. 2 and 3 to thereby correct refractive errors ofthe eye. Again referring to FIG. 4, a ring 47, having an ovaloid crosssectional shape is shown implanted in the stroma layer of the cornea. Byadjusting the diameter of such a ring in the cornea and fixing thatdiameter at a discrete value, the rays refracted by the cornea and othereye components can be brought to focus directly on the retina 18. Such aring placed approximately at the 8 mm chord of the cornea provides ameans for making such a corrective adjustment. Apparatus and methods formaking this adjustment are hereinafter described.

Referring now to FIGS. 6 and 8 of the drawings, the adjusting ring 47 iscomprised of a generally circular member having split end portions 48and 49. The ring is comprised of a material which has sufficientstiffness to maintain its generally circular shape and sufficientresiliency to permit its ends 48 and 49 to be adjusted relative to oneanother to thereby enlarge or decrease the normal diameter of the ringat rest. The material should have properties that render itphysiologically compatible with the tissue of the cornea. Two suchmaterials are plastic type materials sold under the trade namesPLEXIGLASS and SAUFLON. The cross sectional shape of the rings is thatof an oval generally dimensioned to be about 1 mm across its major axisand 0.2 mm across its minor axis. The one insertion end or leading end48 of the adjusting ring is tapered asymmetrically to a rounded tip end(See FIG. 7).

As shown in FIG. 8, the major axis of the oval ring 47 is formed at anangle sloping inwardly to the center of the ring. The angulardisposition of the major axis of the ovaloid ring corresponds to theintended implantation position of the ring 47 in the cornea. The ring isimplanted in the stroma 32 of the cornea as shown in FIG. 4. Onefunction of the stroma is to transfer fluids through the eye. In orderto minimize the effect of the implanted ring 47 on the transfer offluids, the ring is positioned so that its major axis is parallel to thelamellae of the stroma. Thus the ring is implanted at a slopecorresponding to the slope of a corneal arc extending through theanterior pole 20 (FIG. 1) of the cornea. This slope of the adjustingring also corresponds to the direction of lamellae within the cornealstroma. By orienting the ring thusly, the ring may be inserted betweenthe lamellae to produce a minimum of trauma to the eye. During thedevelopment of this procedure, a circular adjusting ring was used. Itwas found however that the circular ring, when expanded or contracted toadjust its size (See FIGS. 2 & 3), creates a sufficient pressure betweenthe corneal tissue and the ring, to cause the ring to cut through thetissue. By utilizing an avaloid shape and orienting the major axis ofthe avaloid as shown in FIG. 4, an enlarged surface is presented in thedirection of pressure of the ring to prevent cutting of the tissue. Thusthe major axis of the ring acts against the lamellae of the stroma inthe direction of pressure and the minor axis is aligned with thelamellae to provide a minimum of interruption to fluid flow.

FIG. 5 of the drawings shows a dissecting ring 51 which is circular incross section and has overlapping split end portions 52 and 53. The endsof the ring overlap approximately one half a diameter of the ring. Ring51 may be constructed of a metallic material such as stainless steel andin any event a magnetic material for purposes to be hereinafterdescribed. Ring 51 also is provided with an asymmetrically rounded endportion 52 having a lower tapered surface to resemble the shape of asled runner. The trailing end 53 of the dissecting ring 51 has a bluntend surface 54.

Referring now to FIG. 7 both the dissecting ring 41 and the adjustingrings have transverse substantially vertical holes 56 and 57respectively through their ends, near the tip ends thereof. Longitudinalgrooves 58 are formed in the top surface of each of the rings 47, 51 andextend from the holes 56, 57 to the respective tip ends of the rings. Aninverted U-shaped clip member 61 is shown positioned in FIG. 7 forreception of its downardly projecting leg portions 62 into the holes 56and 57 of the dissecting and adjusting rings respectively and its bodyportion 63 into the longitudinal grooves 58 in the top end of therespective rings.

Referring to FIG. 10 of the drawings, a dissecting ring holding androtating apparatus 71 is shown including a solid cylindrical rotatingmember 72 having a knurled upper end surface 73. The cylindricalrotating member 72 is slip fitted with a cylindrical holding sleeve 74to permit relative rotation between the member 72 and sleeve 74. Thelower end of the rotating member 72 has a concentrically arrangedconcave surface 76 having its concave shape as well as the proportionsof the surface 76 arranged to be matingly received over the anteriorcorneal surface of the eye. An annular groove 77 is formed in theconcave surface 76 near the peripherial edge of the rotating member 72.This groove 77 is sized to receive and hold the dissecting ring at itsnominal diameter for insertion into and around the cornea at the 8 mmchord of the eye as shown in FIG. 4. This chord is located within aplane across the cornea which measures approximately 8 mm in diameter.Thus the groove 77 itself has an internal diameter of approximately 8mm. The rotatable holding member 72 is constructed of a magnetizedmaterial or has a means for being magnetized. The magnetic nature of themember 72 holds the ring 51 in place on the tool during thekeratorefractive procedure to be described. A small pin 78 is verticallyarranged to project downwardly from a point in the groove. This pincontacts the trailing blunt end 54 of the dissecting ring.

The method of implanting an adjusting ring 47 within the cornea of theeye is as follows: First, a determination is made, by taking opticalmeasurements of the eye, as to what shape the cornea should have inorder for that eye to operate in an optically correct manner. FIG. 11shows a target image comprised of indicia 81. This target grid 81 may bemade by reflecting light from placido rings from a standard sphericalsurface the same size as the eye in question and at a fixed distance. Animage is made of this "correct" topographic map of the eye, referred toherein as a target or target image. The target indicia is in the form ofvertical lines or grids 81 as shown in FIG. 11 which of course may bedrawn in other radial meridians as well as the horizontal meridian asshown. The spacings between the grids 81 represents a topographic surveyof an eye having a corrected curvature, as pertain to the specific eyein question.

A dissecting ring 51 is next placed in the groove 77 on the concavesurface 76 of the rotatable holding member 72. The blunt end 54 of ring51 is contacted against the pin 78 extending outwardly from the groove.The magnetic attraction between the magnetic member 72 and steel ring 51holds the ring in place on the end of the member 72. Next, working undera surgical microscope, a small (approximately 1 mm long and 2 mm deep)incision 82 (FIG. 9) is made in the cornea through the epithilium andBowman's membrane. This incision is approximately the same size as theadjusting ring to be implanted. The leading end 52 of the dissectingring 51 is then moved through the incision and into the stroma of thecornea. The holding member 72 is then rotated to progressively threadthe ring around the cornea between the adjacent lamellae within theanterior portion of the stroma. The lamellae of fibrils near theanterior of the stroma are more lossely formed, making this a desirablelocation in the stroma for insertion of the dissecting ring and forimplantation of the adjusting ring. The sled shaped nose portion on theend 52 of the dissecting ring causes the end 52 to be continuouslybiased upwardly sufficiently to maintain the ring 52 in a path in theanterior lamellae of the stroma. The magnetic force between the holder72 and the dissecting ring also causes the dissecting ring to maintainits path within the anterior lamellae. Rotation of the holding member 72is continued with the pin 78 and magnetic attraction between the ring 51and holder 72 serving to drive the ring about the cornea until the endportion 52 reaches the incision 83. At this time, a second incision(FIG. 9) is made perpendicular to the first incision, with the secondincision being approximately 1 mm long. In any event the second incisionextends from a position just above the hole 57 in the dissecting ring toa normal intersection with the first incision 83. The leading end 48 ofthe adjusting ring 47 is then brought into position with its tip endadjacent the tip 52 of the dissecting ring now lying below the cornealsurface. As shown in FIG. 7, the clip member or link 61 is now placedwith its leg portions 62 projecting into the holes 56 and 57 in therespective adjusting and dissecting rings and the body portion 63 ofclip 61 is passed through the second incision 82 into position in thegrooves 58 in the top side of the respective rings.

Next the holding member 72 is rotated in an opposite direction pullingthe leading end 48 of the adjusting ring through the incision 83 andaround the circular path previously made by the insertion of thedissecting ring. The dissecting ring is moved in reverse rotation withthe member 72 by means of the magnetic force between the holder 72 andring 51. The plastic adjusting ring 47 is pulled by the metal dissectingring. As the adjusting ring 47 is drawn into the cornea, the dissectingring is being progressively withdrawn or "backed-out" until the leadingend 48 of the adjusting ring is brought circularly back around to theincision 83, at which time the dissecting ring is fully withdrawn. Thelink 61 is then removed from the holes 56, 57 and slots 58 to releasethe connection between the dissecting and adjusting rings. The tip endsof the split ends 48, 49 of the adjusting ring are then grasped, such asby the ends of an adjustable caliper, and adjusted longitudinallyendwise relative to one another to adjust the diameter of the ring andthereby bring the shape of the cornea into coincidence with the indicia81 on the target image (FIG. 11). Also shown in FIG. 11 is an image ofsomewhat concentric circles 83 similar to that projected from a viewingsurface by a corneascope. The rings are produced by reflecting lightfrom placido rings onto the present corneal surface being worked on. Thedistances from placido rings to cornea to image surface is the same asfor constructing the target image. The concentricity and spacings of therings 83 represents the topography of the eye being worked on. Bysuperimposing the rings 83 onto the target image while adjustment of theends of the adjusting ring 47 is taking place, perfect corrections ofthe corneal shape may be affected by manipulating the ends of theadjusting ring until the indicia 81 and circles 83 are brought intocoincidence. The ends 48, 49 of the adjusting ring 47 are then fixedtogether such as by gluing or the like to permanently fix the correctshape of the cornea.

While particular embodiments of the present invention have been shownand described, it is apparent that changes and modifications may be madewithout departing from this invention in its broader aspects, andtherefore, the aim in the appended claims is to cover all such changesand modifications as fall within the true spirit and scope of theinvention.

What is claimed is:
 1. An apparatus for inserting an adjusting ring intothe anterior of the cornea for making adjustments in the shape of thecornea, including: a planar ring shaped cutting member for insertioninto the cornea of the eye and having overlapping end portions,one endof said ring shaped cutting member being substantially rounded to permitits easy movement through a planar circular path in the tissue of thecornea, means near said one end of said ring shaped cutting member forreleasably attaching one end of an adjusting ring; and holding means forholding said cutting member while it is being moved through the cornealtissue, said holding means having a concave surface sized to matinglyreceive the convex outer surface of the cornea of the eye.
 2. Theapparatus of claim 1 wherein said one end of said ring shaped cuttingmember is asymetrically rounded in a sled shape to bias said ring shapedcutting member in a direction transverse to its path of movement as itmoves within the corneal tissue.
 3. The apparatus of claim 1 whereinsaid ring shaped member is substantially circular in cross sectionalshape.
 4. The apparatus of claim 1 wherein said ring shaped cuttingmember has magnetic properties and said holding means includes a magnetmeans for applying a holding force to said cutting member.
 5. Theapparatus of claim 1 wherein said releasably attaching means includes ahole near said one end of said ring shaped cutting member and alongitudinal slot in the upper facing surface of said ring shapedcutting member extending from said hole to the tip end of said one endof said ring shaped cutting member.
 6. The apparatus of claim 4 andfurther including a circular groove concentrically formed within saidconcave surface for receiving said ring shaped cutting member andmaintaining said ring shaped cutting member in a circular path as it isbeing moved through the corneal tissue.
 7. The apparatus of claim 6 andfurther including means in said groove for engaging the other end of thecutting member to facilitate movement of said cutting member into andthrough the corneal tissue.
 8. The apparatus of claim 7 wherein theother end of said cutting member is blunt to facilitate its engagementwith the engaging means on said holding means.
 9. An apparatus forinserting an adjusting ring into the anterior of the cornea for makingadjustments in the shape of the cornea, including; a ring shaped cuttingmember for insertion into the cornea of the eye and having overlappingend portions;one end of said ring shaped cutting member beingsubstantially rounded to permit its easy movement through a circularpath in the tissue of the cornea; means near said one end of said ringshaped cutting member for releasably attaching one end of an adjustingring; holding means for holding said cutting member while it is beingmoved through the corneal tissue, said holding means having a concavesurface sized to matingly receive the convex outer surface of the corneaof the eye.
 10. The apparatus of claim 9 and further including acircular groove concentrically formed within said concave surface forreceiving said ring shaped cutting member and maintaining said ringshaped cutting member in a circular path as it is being moved throughthe corneal tissue.
 11. The apparatus of claim 10 and further includingmeans in said groove for engaging the other end of the cutting member tofacilitate movement of said cutting member into and through the cornealtissue.
 12. The apparatus of claim 10 wherein the other end of saidcutting member is blunt to facilitate its engagement with the engagingmeans on said holding means.
 13. A system for implanting an adjustingring into the corneal tissue of the eye for permitting adjusting of theshape of cornea, including;ring shaped dissecting means having split endportions to permit insertion of one end portion into the tissue of thecornea while the other trailing end portion is outside the anteriorsurface of the cornea; means for holding said dissecting means formovement within the cornea; ring shaped adjusting means having split endportions to permit insertion of one end portion into the corneal tissuewhile the other trailing end portion is outside the anterior surface ofthe cornea; and means for releasably connecting said respective one endportions.
 14. The system of claim 13 wherein said ring shaped adjustingmeans is ovaloid in cross sectional shape.
 15. The system of claim 14wherein the major axis of said ovaloid shaped adjusting means isarranged to be aligned, when inserted within the cornea, with the slopeof a corneal arc passing through the anterior pole of the cornea. 16.The system of claim 13 wherein said respective one end portions eachhave an asymetrically rounded tip end for generating a transversebiasing force to the end portion when it is moving in an insertingdirection within the corneal tissue.
 17. The system of claim 13 whereineach of said respective one end portions have holes near their tip endsfor connecting said respective one end portions.
 18. The system of claim17 including removable clip means for insertion into said holes forholding said dissecting means and adjusting means from relativelongitudinal movement.
 19. The system of claim 18 and further includinglongitudinal slot means in the upper surface of said adjusting means anddissecting means, said slot means extending from said holes to the tipend of the respective one end portions.